Surgery in the Multimodal Management of Gastric Cancer

Cancer cachexia is a multifactorial paraneoplastic syndrome characterized by anorexia, decreased body weight, and loss of adipose tissue and skeletal muscle. It accounts for at least 20% of deaths in neoplastic patients. Cancer cachexia significantly impairs the quality of life and the response to anti-neoplastic therapies, thereby increasing morbidity and mortality of cancer patients. Muscle wasting is the most important phenotypic feature of cancer cachexia and the principal cause of function impairment, fatigue, and respiratory complications, mainly related to the hyperactivation of muscle proteolytic pathways. Most therapeutic strategies aimed at preventing cancer cachexia have proven to be only partially effective. The inhibition of catabolic processes in muscle has been attempted pharmacologically, with encouraging results in animal models. However, data in the clinical setting are scant and contradictory. Stimulation of muscle anabolism could represent a promising and valid therapeutic alternative for cancer-related muscle wasting.